CNM Purple Thin Book Study Questions 2013 Flashcards
Cancer screening recommendations from American Cancer Society on mammograms
Women age 40 or older should have annual mammograms continuing for as long as the woman is in good health
Cancer screening recommendations from American Cancer Society on Paps
Age 21-29, q 3 yrs if wnl
Age 30-39 q 5 yrs if wnl (with HPV testing)
Age 40+ …
Cancer screening recommendations from American Cancer Society on fecal occult blood testing FOBT
shoudl be conducted annually starting at age 50
Cancer screening recommendations from American Cancer Society on sigmoidoscopy/colonoscopy
Starting at age 50 sigmoidoscopy q 5 yrs -OR- colonoscopy q 10 yrs -OR- double-contrast barium enema q 5 yrs -OR- CT colonography q 5 yrs
CDC recommendations for 65 yr old
Influenza should be given annually.
All immunocompetent individuals 65 or older should be immunized once with pneumococcal vaccine (one-time revax if vax 5 or more years previously and less than 65 at time).
Adults should receive Td booster vax q 10 yrs.
Herpes zoster vax rec for individuals age 60+.
Fat intake recommendations from AHA
Total fat 25-35% of total daily caloric intake
Saturated fats <1% tdci
Where are trans fats found?
in products that contain partially hydrogenated fat
as well as in meat and whole-fat dairy products
One strategy for replacing saturated fats with unsaturated fats
Replace meats with veg alternatives (eg beans) or fish
Will reduce cholesterol content
Sat fat v cholesterol content in peanut butter
low in cholesterol
high in saturate fat
Five stages of Thranstheoretical Model for Change
precontemplation contemplation action maintenance/relapse prevention relapse
Bupropion
antidepressant which is helpful in smoking cessation (likely due to effect on neuroal uptake of dopamine, prolonging action of nt)
Weight gain NOT a s/e
Start bupropion 1-2 wks before quit date so blood levels of med will be satbilized.
Bupropion is C/I in sz disorder and eating disorders
Criteria for dx of IBS
Continuous or recurrent sx, for at least 3 months of:
abdominal pain or discomfort relieved with defecation -OR- associated with a change in frequency or consistency of stool
Must also have irregular pattern of defecation at least 25% of time with =3/+ of:
altered stool frequency/form/passage, passage of mucus and bloating, or feeling of abdominal distention
Typical IBS does NOT waken individual nor does it result in significant weight loss
Physical activity generally does not cause an increase in severity of sx.
Regular physical exercise may be beneficial
Appropriate treatment for both diarrhea and constipation IBS
increasing dietary fiber, which will result in a bulkier stool.
Bulk forming agents such as psyllium husk fiber and methylcellulose can also be used.
What laxative types are ok occasionally for pt with constipation IBS?
stool softeners
osmotic laxatives
What type of laxatives should be avoided as much as possible in someone with constipation-predominant IBS?
Avoid stimulant laxatives
26 yr old with abrupt-onset diarrhea that began 24 hours ago; has had approx 6 loose stools without noticeable blood; mild abdominal cramps, neg nausea, neg fever.
Acute diarrhea. Usually self-limiting.
Maintain oral hydration rich in electrolytes.
Restart foods slowly as toleated with clear liquids and then carbs.
Resume protein and fats last.
Stool culture may be indicated if sx persist and/or fever/bloody stools.
32 yr old. 3-month hx intermittent burning retrosternal pain that radiates to her back.
Sx noted 30-60 minutes after meal; relieved quickly with antacids. PE and VS wnl.
GERD gastroesophageal reflux disease
sx include intermittent nature,
association of relief with antacids
cholecystitis
Usually colicky, constant, in RUQ
Deep inspiration usually causes severe pain and splinting of repirations (Murphy’s sign)
If gastric irritation with ingestion of iron supplement on empty stomach (recommended):
Ingest with food to reduce irritation.
Try another preparation.
Increase slowly from small dose.
Antacids for gastric irritation while taking iron supplement:
inhibit absorption
to increase iron absorption
take iron supplement with vit C
test to determine iron stores
serum ferritin level (major storage protein)
Is located in serum [ ] directly r/t iron stores
test of choice for distinguising bt carrier and affected state of sickle cell
Hgb electrophoresis
test which is very effective at distinguishing types of hemoglobin in a blood sample
Hgb electrophoresis
Is Sickledex a screening or diagnostic test
screening test for SCA/SCT; must be confirmed with Hgb electrophoresis
When to migraine HA usually begin
adolescence or early adulthood, though they can occur in young children
where are migraines usually located?
unilaterally
sx of migraine HA
throbbing,
can last up to 72 hours
often accompanied by nausea and photophobia
what is indicated for preventive therapy of migraine HA that come 2 or more x/mo?
beta-adrenergic blocking agents (propranolol)
meds used for abortive or analgesic therapy of acute migraines
codeine-containing products
ergotamine preparations
sumatriptian
carpal tunnel sx
dull aching pain across wrist and forearm
with paresthesia, weakness or clumsiness of hand.
Nocturnal pain and radiation of pain up to proximal forearm.
PE may also identify muscle atrophy and dry skin of affected hand
Tinel’s sign
elicited by tapping over median nerve at th e palmar surface of wrist
+ Tinel’s sign
client has tingling or prickling sensation along first three digits
wrist pain
weak grip
Seen in carpal tunnel syndrome
+Phalen’s sign
client experiences numbness and paresthesia in fingers innervated by median nerve after maintaining palmar flexion for 1 minute
Seen in carpal tunnel syndrom
Most common cause of sciatica
herniated intravertebral disk
sx of herniated intravertebral disc
low back pain
burning that radiates along lateral thigh, leg and foot
PE findings of herniated disc
pain below knee with elevation of affected leg with pt in sitting or supine (+straight leg raise).
Pain could also be in buttocks and posterior thigh
exercises helpful in preventing recurrence of lumbosacral back strain
abdominal strengthening exercise
relief measures for lumbosacral back strain
heat, cold packs, or both.
Limit bedrest to 2-3 days.
Back stretching are of LITTLE VALUE
osteoarthritis
degenerative dz of cartilage of joints.
most common form of chronic arthritis (up to 25% adult pop)
common presenting hx of osteoarthritis
asymmetrical joint pain and stiffness that improves through day
joints typically involved in osteoarthritis
distal and proximal interphalangeal joints, hips, knees and cervical/lumbar spine
PE for osteroarthritis
crepitus; limited ROM of joints
Joints feel cool with bony enlargement
Constitutional signs like fatigue and malaise NOT CHARACTERISTIC
Fibromyalgia
unexplained widespread pain or aching, persistent fatigue, generalized morning stiffness, non-refreshing sleep, multiple tender points bilaterally in UE/LE.
NOT CHARACTERISTIC:
changes in ROM, swelling in joints, abnormal neurologic findings
Contact Dermatitis
pruritus or burning at site of contact of an irritant or allergen.
Lesions vary depending on stage of response. In acute stage, erythema and oozing vesicles common.
Fungal infection
typically affects scalp, trunk, limbs, face, groin or feet.
Characterized by erythematous scaling plaques
Cellulitis
characterize by diffuse, sharply defined erythema.
Red streaks run from cellulitis to regional lymph nodes
Scabies
characterized by minute vesicles and linear runs or burrows often found in digital webs, palms, writs, gluteal folds, buttocks, and toes
Pt presents with recent onset of irregular patches of erythema and oozing vesicles on hands, itching and burning of affected area. What is it?
uncomplicated contact dermatitis
tx for uncomplicated contact dermatitis
topical corticosteroid agents are generally effective in tx of mild, umcomplicated contact dermatitis. (more severe epidoses may need systemic corticosteroid therapy)
Lyme dz PE
erythema migrans is annular and erythmatous with central pallor at site of tick bite. Lesion starts about 5cm and quickly grows to ~20 cm.
Typically appears within 1 wk-1 month after tick bite.
Nonpruritic
s/s of lyme dz
constitutional sx such as fatigue, myalgias, arthralgia, HA and fever during localized phase that extend to sx of involvement of other organ systems if not tx early
squamous cell carcinoma
ulcerated nodule with translucent surface and firm raised borders on the face
Second most common skin cancer. Squamous cells compose most of skin’s upper layers (epidermis).
SCCs often look like scaly red patches, open sores, elevated growths with central depression or warts; may crust or bleed.
SCC mainly caused by cumulative UV exposure.
Lesion starts as a firm nodule or papule with thick scale that becomes eroded, crusted and ulcerated with raised pearly borders.
basal cell carcinoma
usually appears on head, neck or hands as a small nodule that left untreated begins to bleed and crust over.
Characteristics of malignant melanoma
A -asymmetry B-border ireegularity or notching C-color variation D - diamater >6mm Seen in all ages
temporal arteritis
sharp, throbbing or aching pain localized to the temporal area.
Other symptoms may include scalp tenderness, jaw pain with chewing, anorexia, weight loss, fatigue.
Individual my have known hx of polymyalgia rheumatica.
Unilateral blindness may occur if untreated. Age of onset usually older than age 50.
Erythrocyte sedimentation rate will be >50 mm/hr.
PE findings of temporal arteritis
fever, tenderness over a nodular temporal artery, decreased pulsation of the artery, diminished or absent pulses in upper extremities.
sx of viral conjunctivitis
gradual onset of unilateral (may become bilat) scratchy sensation in the eye. No eye pain, vision changes or photophobia.
PE of viral conjunctivitis
peripheral injection and a watery discharge.
Allergic conjumctivitis
bilateral, both eyes are itchy.
Peripheral injection and mucoid discharge.
Corneal abrasion
typically pain and photophobia
subconjunctival hemorrhage
painless, no discharge
There is a splash of blood in conjunctiva and sclera.
Substance dependence definition
maladaptive pattern of substance use, in the presence of at least 3 of 7 elements, occurring at any time in the same 12-month period. One element is a persistent desire to use the substance and/or unsuccessful efforts to cut down use.
May experience tolerance (need more amt over time to achieve same effect) or withdrawal (substance-specific syndrome when substance stopped/decreased)
substance abuse
Fail to fulfill major role obligations
Use substances in situations that are physically hazardous
Experience substance-related legal problems
Continue to use substances despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of the substance
acanthosis nigricans
velvety hyperpigmented patch found on back of neck, elbows, knuckles, knees, groin and axillary areas in obese women with mod-severe insulin resistance.
Can also be seen in older adults with malignancies of GI tract and other adenocarcinomas
Interstitial cystitis
aka painful bladder syndrome: pelvic pain, pressure or discomfort, typically associated with persistent urge to void or urinary freqency, in the absence of infection or other pathology.
Nocturia common.
Incontinence uncommon.
Dyspareunia frequently seen in women with IC.
s/s of anorexia nervosa
Depression is comon.
Intense fear of loss of control.
Amenorrhea is a dx criteria.
s/s of bulimia nervosa
Depression in about 50%.
Alcohol/drug abuse and lack of control
May lead to menstrual irregularities but usually not amenorrhea
Dx criteria for Major Depressive Episode
Five of the following during the same 2-wk period, represent a change from previous functioning, and include 1 of first 2.
- depressed mood most of day by self-report or by others
- loss of interest in most activities, most of day, nearly every day
- significant weight change without trying, or daily change in appetite
- insomnia/hypersomnia ~daily
- psychomotor agitation or retardation per report of others
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think or [ ], or indecisiveness
- recurrent thoughts of death, suicidal ideation with or without plan
First line tx for major depression
SSRIs and heterocyclic antidepressants
SSRIs
eg, paroxetine
usually have an ENERGIZING effect and may lead to insomnia if taken at night, or even if taken during day
Heterocyclic antidepressant
eg, Trazadone
sedative effect; most benefical to take it at night
ADA recommendations to reduce risk of CVD in people with DM
HbA1c < 7% of total
Weber test
tuning fork on top of head, equally between ears
Defective ear hears it loudest - signifies conductive hearing loss
because room noise will not be heard as well; detection of vibration in the impaired ear improves
causes of conductive hearing loss
cerumen impaction, foreign bocy in ear, otitis media, perforated eardrum
Cranial Nerve V Trigeminal
has both motor and sensory functions.
Motor fxn tested by palpating temporal and masseter muscles while having pt clench teeth.
Sensory fxn tested by evaluating pain and light touch sensation along the forehead, cheeks and jaw.
inflammation of the pericardial sac with pericarditis produces what sound?
friction rub: a high-pitched scratchy sound with 2-3 short components associated with cardiac movement
sx of pulmonary embolism
sudden onset of SOB, localized pleuritic (sharp with breathing) chest pain, apprehension, bloody sputum production, diaphoresis, fever, hx of conditions causing risk for embolism.
Prolonged immobilization as may occur with long periods of air travel poses a risk
PE finidings for pulmonary embolism
restlessness, fever, tachycardia, tachypnea, diminished breath sounds, crackles, wheezing, and pleural friction rub
s/s of mitral valve prolapse
sharp, nonexertional chest pain of short duration.
May be accompanied by palpitations and diaphoresis; anxiety and/or panic attacks.
Often asymptomatic.
Diagnostic hallmark of mitral valve prolapse
midsystolic click, a late systolic murmur, and an abnormally thickened, redundant mitral valve seen on echocardiogram
Primary hypothyroidism
elevated TSH, suppressed FT4
periobital edema, among other things
female pubescent growth
beginning of accelerated growth is usually first sign of female puberty, but breast budding is first recognized pubertal change, followed by appearance of pubic and axillary hair.
Peak growth occurs about 1 yr before menarchei
viral pharyngitis s/s
malaise, fever, HA, cough, congestion and fatigue along with sore throat.
PE include pharyngeal erythema, no/small amt exudate, neg lymphadenopathy
bacterial pharyngitis
sudden onset of severe sore throat and fever.
Usually no cough, no congestion.
PE includes fever of 101.5 or higher, pharyngeal erythema and exudate, and anterior cervical lymphadenopathy
Objective information is obtained during
PE or lab or dx test
Subjective information includes
all aspects of the health hx from chief complaint through review of systems
Problem list is ob/sub jective?
may be combination of both
s/s of hyperthyroidism
nervousness, increased perspiration, weight loss despite an increased appetite, frequent bowel movements.
exam findings include incr patellar reflexes, HR high side of normal, moderately enlarged, soft, nontender thyroid gland
Grave’s dz
comprises 70% of hyperthyroid cases and is seen most commonly in women 20-40 yr old.
Subacute thyroiditis
a postviral illness that may cause transient hyperthyroidism. Thyroid is usually tender.
Lipid screening
recommended q 5 yrs for all adults over 20 yr.
If screening is nonfasting total cholesterol and HDL, a follow-up fasting lipid profile should be done in the following situations:
total cholesterol 200 or more
HDL less than 40
test results borderline in individual with 2 or more CVD risk factors
CVD risk factors
female 55 yrs and older premature menopause male 45 yrs and older family hx of premature CVD smoking hypertension HDL <40
CVD risk equivalents
diabetes stroke known cerebrovascular dz peripheral vascular dz abdominal aortic aneurysm
Bacterial pneumonia
pleuritic chest pain, cough productive of yellow sputum, elevated temp, elevated respirations, HR high nl, somewhat dehydrated
PE bacterial pneumonia
findings of consolidation assoc with pneumonia would include increased vocal fremitus, presence of bronchophony, dullness to percussion over affected lung areas
American Cancer Society guidelines for colon cancer screening
start at age 50
single-specimen FOBT not rec option (5% sensitivity). six-sample home FOBT 24% sensitive.
Vit C may cause false-negative results.
Pos results on FOBT shoudl be followed up with colonoscopy
CDC criteria for considering 5-10 mm induration a +tuberculin skin test
HIV infection, recent close contact with a person with active TB infection, fibrotic lesions or evidence of old, healed TB on chest radiograph, or immunosuppression
ANA + in?
autoimmune dz such as RA SLE scleroderma Sjorgren's syndrome
SLE management
Local and systemic corticosteroids are used in tx.
Avoid strong sunlight and use sunscreen and protective clothing to avoid extensive exposure that can exacerbate lupus skin rash and active dz.
Women with SLE who have unknown or +antiphospholipid antibodies should not use ESTROGEN-containing contraception. Progestin-only contraception, non-hormonal IUDs, and barrier methods may be acceptable.
Autoimmune antibody testing is used in dx of SLE.
HIV testing
both enzyme immunoassay (EIA) and rapid HIV are considered highly sensitive as initial screening tests for HIV. Must be confiremed by Western blot or immunofluorescense assay.
Hepatitis B surface antibody (HBsAB)
appears approx 4-5 months after infection; is an indicator of immunity. Also detectable in individuals who have passive immunity secondary to hep B vaccination
Chronic fatigue syndrome
For 6 months or more:
fatigue that interferes with physical, mental, social and educational activities PLUS
4 of the following eight things:
sore throat
short-term memory or concentration impairment
tender cervical or axillary lymph nodes
headaches of a new type/pattern/severity
unrefreshing sleep
postexertional malaise lasting more than 24 hours
multijoint pain without swelling or inflammation
muscle pain
Evidence-based tx for Chronic Fatigue Syndrome
A supervised, graded aerobic exercise program results in improvements in fatigue and physical functioning.
Cognitive behavioral therapy is beneficial.
There is insufficient evidence to support benefits of antidepressants, corticosteroids, or multivitamins.
